(1239) Evaluation of Mucoactive Practices in Adult Inpatients

Introduction: Acute respiratory failure leads to significant morbidity and mortality. Mucus secretion and clearance is a physiological defense mechanism that is impaired by mechanical ventilation, increasing risk for sputum retention and subsequent complications. Mucoactive agents (e.g. N-acetylcysteine [NAC]) are commonly used at our institution, with high medication costs, despite limited data supporting their use. To evaluate our clinicians’ practices, we designed a survey which could be used to design an institutional protocol for mucoactive use.

Methods: An anonymous, electronic survey was distributed within our institution to prescribers with experience with mucoactives (e.g., interventional pulmonology, pulmonary and critical care medicine [PCCM]) and respiratory therapists in July 2024. The survey was designed by an interdisciplinary group and was evaluated for face content and validity prior to dissemination. The survey included questions evaluating: (1) demographic characteristics; (2) awareness and knowledge of published literature; and (3) clinical practices, including outcomes.

Results: Of survey respondents, the majority were PCCM attendings, with at least 6 years of experience. Guaifenesin was the most commonly used mucoactive (80%), followed by inhaled NAC (70%), with the most common indication being bronchiectasis. The majority indicated that their prescribing practices vary by severity (ICU, ward). In evaluating understanding of literature, 90% responded that they do not believe there are clearly established patient-specific outcomes, and no participants agreed that they have shown to have significant clinical benefit. Hospital mortality was the clinical outcome that was ranked highest priority for studies regarding mucoactives, followed by ventilator-free days. The majority of respondents routinely evaluate patient response to mucoactives and believe that mucoactives only benefit few patients (up to 20%).

Conclusions: The majority of survey respondents believe that mucoactives have limited clinical benefit based on published literature and clinical experience. Mucoactive prescribing practice varied by patient location severity. Future studies should evaluate clinically relevant outcomes (e.g., hospital mortality, ventilator-free days).